Provider Demographics
NPI:1194318485
Name:YAH ORTHO INC
Entity type:Organization
Organization Name:YAH ORTHO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAWEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BIELECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-435-1550
Mailing Address - Street 1:3821 W PUEBLO BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2713
Mailing Address - Country:US
Mailing Address - Phone:719-564-6467
Mailing Address - Fax:
Practice Address - Street 1:317 W 3RD ST STE 103
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1401
Practice Address - Country:US
Practice Address - Phone:719-564-6467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YAH ORTHO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty